FDAR

CASE PRESENTATION ON ANTEPARTUM HYPERTENTION

I. INTRODUCTION
We, the Level 2 N1 (Group 2) Nursing students would like to thank Vicente Sotto
Memorial Medical Center for allowing us to choose a patient for our case. We also thank
our clinical instructor, Mrs. Marnellie B. Obeso, RN, MAN for patiently teaching us and
making sure that we all have learn the most from our clinical exposure.

GENERAL OBJECTIVES
After the case presentation, the Level 2 N1 (Group 2) Nursing students will be able to
gain knowledge and skills in caring for patients with Antepartum Eclampsia.

SPECIFIC OBJECTIVES
The level 2 Nursing students will be able to:
• Define Antepartum Eclampsia.
• Enumerate the possible cause of the Antepartum Eclampsia
• Identify the cause and effect of Antepartum Eclampsia.
• Accurately present a thorough general health assessment of the patient which
include history taking.
• Accurately present a thorough general health assessment of the patient which
include physical assessment.
• Accurately present a thorough general health assessment of the patient which
include Gordon’s functional health pattern.
• Discuss the anatomy and physiology.
• Describe the diagnostic tests used, its results and significance.
• Appropriately apply nursing interventions necessary for the patient’s condition in
reference with the learn theories and concept of the disease and medical
management (drugs).
• Convey the significance of patient’s response to the rendered nursing interventions.
• The nursing diagnostic problems and discharge plan.

II. NURSING HEALTH HISTORY

Patient History
A case of L.J.A 26 year old, Filipina, catholic, married, G2P2 (1001) from
Mag-atubang, Tuburan Cebu. LMP: January 7, 2019, AOG 34 4/7 weeks.
Admitted at Vicente Sotto Memorial Medical Center. With the admitting
diagnosis G2P2 (1001) PU 33 4/7 weeks AOG Breech Presentation. 

Menstrual History:
  Patient’s menarche started at 15, duration of 2-3 days, regular menstrual cycle of 28-30
days. using 3-4 pads moderately soaked, has dysmenorrhea. 

Sexual and Contraceptives

Coitarche at the age of 18, one sexual partner, with the use now of
contraceptive pills, pap-smear is negative and is positive for dysmenorrhea. 

Obstetrical History
G2P2 (1001); P1 2016, normal spontaneous vaginal delivery, male, weight of
 3.1 kg and P2 current pregnancy with the last menstrual period of January 7,
2019.
Past Medical History
Patient’s immunizations was completed and no know allergies. Patient does
not have any maintenance drugs nor takes in medications, with history of
genetic diseases in the family.
Family History
Has history about positive hypertension both parents and negative with
diabetes mellitus.
GENOGRAM:
FATHER’S SIDE MOTHER’S SIDE

† † † ♥
♥ ♥ ♥

♥ ♥ ♥ ♥

Legend:
†- Deceased
♥- Hypertension
P- Patient

Personal and Social

Patient is a high school graduate and as of the moment, unemployed.
 
Chief Complaints
- Labor pains
III. GORDON’S FUNCTIONAL HEALTH PATTERN and REVIEW OF SYSTEMS

GORDON’S BEFORE DURING

FUNCTIONAL
HEALTH PATTERN
1. Health Ms. L was admitted due to Upon admission, the patient
Perception / epigastric pain at dawn of has been in a Post-
Health November 23, 2019 and Cesarean section and has
Management antepartum eclampsia. She complained of pain in her
has undergone into Lower abdomen.
 segment transverse Cesarean
Section on the same day. She
had a blood pressure of
140/100.
Ms. L is fond of eating rice and Upon admission, the patient was
2. Nutritional - salty, fatty foods. Her daily diet NPO for a day and later advised to
usually consists of pork and rice. a soft diet.
Metabolic She often drinks cola or any soft
drinks. Ever since Ms. L got
pregnant, she started to gain more
weight and doesn’t have any
complications throughout her
pregnancy.
Ms. L urinate about 6-7 times Upon admission, the patient,
3. Elimination a day with various amounts. as ordered by the doctor, a
She eliminates her bowel Foley bag catheter insertion
every other day usually in the attached urine bag. This is
morning with a soft and brown where the patient’s urine is
stool in color. collected and as nurse’s our
duty to discard and record
the ml of the urine output.

The patient works as a The patient has minimal

4. Activity – Exercise barangay health worker and
doesn’t have any difficulty in
doing her daily task. She
does. The client slept for
about 7 hours a day. She
slept at 10 in the evening and
wake up at 5 in the morning.
Doesn’t have any trouble
sleeping and sometimes do
exercise when she have her
available time.
For about 7 hours a day. She
5. Sleep – Rest slept at 10 in the evening and
wake up at 5 in the morning.
movements like lying on the
bed, sitting and
breastfeeding her baby. She
needs minimal assistance
from her SO when taking a
bath and etc.
The client was not able to
sleep properly since she
doesn’t have a share in the
bed

The patient is a high school

6. Cognitive – level graduate at Tuburan
Perceptual High School. She wasn’t able
to continue on her education
because of financial
problems. Despite her
education level, she is
capable of reading and
writing.
Ms. L is very cooperative
and coherent in answering
our questions for our
interview which coincides in
her records.
 Ms. L is married with two (2)
7. Self – Perception / kids. She is a housewife and
Self-Concept mostly do the household
chores. Walking and jogging
is a form of her exercise.
The patient is very attentive
especially when it comes to
her baby. She can’t wait to
be home because she
misses her child very much.

Ms. L speaks bisaya language Upon admission, Her

8. Role - only and has a clear voice in
Relationship sharing her story and Opinion.
She is currently living at
Tuburan with her family. And
work as a BHW to also
provide and sustain her family
in everyday life.
relationship with her family is
stable and she can rely on
them throughout the
pregnancy and admission to
the hospital. Patient is very
responsive when it is about
family- related questions.

Ms. L is very much married to The patient has just

9. Sexually – her husband for about 8
Reproductive years. The patient only use
contraceptives when it come
to her family planning method.
Ms. L had her menarche
when she was 15 years old.
She has a regular menstrual
cycle.
Ms. L and her husband makes
10. Coping / their decisions together. She
Stress was able to cope up with her
Tolerance stress by looking at her kid
and spend some time with
them. She also do some
household chores to distress
herself.
The patient is a high school
11. Value - Belief level graduate at Tuburan
High School. She wasn’t able
to continue on her education
because of financial
problems. Despite her
education level, she is
capable of reading and
writing.
undergone
Cesarean Section and has
not had a positive outcome
in their laboratory result.
She is mostly stressed about
her environment and being
weak because of her
sickness. She just sleeps her
stress away and wait for the
right time the doctor will have
a go sign for her to go home.
Ms. L is very cooperative
and coherent in answering
our questions for our
interview which coincides in
her records.

Summary:
Ms. L was admitted due to epigastric pain at dawn of November 23,
2019 and antepartum eclampsia. She has undergone into Lower segment
transverse Cesarean Section on the same day. She had a blood pressure of
140/100. Her usual diet is consists of rice and pork and a fond of drinking soft
drinks. She usually urinates 6-7 times a day and eliminates her waste every
other day. She works as a barangay health worker and sleeps for about 8
hours. She is a high school graduate and married with a kid. They used
 contraceptives as their form of family planning method. She has a good
relationship with her family and the family supported her throughout the
pregnancy and admission. She has a strong faith in her religion but it doesn’t
interfere with her admission to the hospital.
Upon admission, the patient has been in a Post- Cesarean section and
has complained of pain in her abdomen. She was NPO for 24 hours and was
switched to soft diet. She has a Foley bag attached to urobag hasn’t been
eliminating her waste for 2 days. Due to the inconvenience of the place and
pain in her abdomen, she has minimal movements like sitting on the chair most
of the time and walking to the nurse’s station. The patient doesn’t have much
sleep due to the inconvenience of the place but she was very cooperative in
answering questions of the health care providers. She is a family- oriented
person and she was very happy with her baby. She rely on the support of her
family throughout the pregnancy

IV. PHYSICAL ASSESSMENT and REVIEW OF SYSTEMS

PHYSICAL FINDINGS REVIEW OF SYSTEMS
ASSESSMENT
Inspection:  Ecchymosis which is
SKIN  warm, clean, fair-light and characterized as bluish to
pinkish skin purple skin discoloration
 Bruise on mid-arm due to caused by the escape of
sugar reading blood tissues from ruptured
 No lesions, rashes noted blood vessels. It was evident
on the arms and legs of the
 Clean and cut  nails
patient.
 No odor noted
 Flat moles observed Bruise was noted due to the
Palpation: sudden fall or accident that
 capillary refill at less than 2 was stated by the patient
seconds

Inspection:
HAIR  No sign on infection and
infestation.
Palpation:
 black, coarse, thin, ruffled
long  hair,
 texture and oiliness of hairs
are evenly distributed

Inspection: Moon shaped face and thin

HEAD  thin eyebrows hair may be indicative of
Cushing syndrome or steroid
 Eyebrows same color as hair. treatment. 
 No masses, lesions on the
head noted.
 Moon shaped.
Palpation:
 No masses while palpitating.
Inspection:
FACE  Symmetrical
 Skin is smooth without
lesions.
  Skin same color as the
neck.
 Puffy face.
Palpation:
 No masses when
palpated.
Inspection:
EARS  auricles are symmetrical and
aligned to the outer canthus
of the eye
 clean ear canal with right
cerumen amount
Palpation:
 auricles are mobile, firm and
not tender,
 Pinna recoils when folded
 responds to normal voice
tones
Inspection:
EYES  dark, symmetrical and equal
size iris
 shiny, white palpebral
conjunctiva
 pupils equal and reactive to
light
 ocular muscles observed
 right vision observed-
 anicteric sclera

Inspection:
NOSE  intact nasal septum
 symmetric and no nasal flares
 No tenderness, masses and
lesions found
 Nasal mucosa is pink
 Not allergic
Inspection: Dark chapped lips may
MOUTH  dark, chapped lips indicate dehydration,
tiredness. Proper dental
 yellowish and misaligned hygiene is need for emphasis
adult teeth with some caries
and assistance for the patient.
 Uvula is positioned midline in
the soft palate
 tongue is pink with no lesions
 buccal mucosa is red and
moist

Inspection:
NECK  symmetrical
 No lesions noted.
 Neck muscles equal in size
 no masses and lesions are
observed
 Palpation:
 trachea and landmarks
positioned at midline
 no thyroid masses
 thyroid is smooth, non-tender
and firm
Auscultate:
 no bruits

Inspection: Pregnancy induced

CHEST (Anterior /  breast are symmetrical noted hypertension and poorly
visible veins controlled insulin-dependent
Posterior) diabetes are the contributing
 outer dark brown areola factor of low milk production
 less milk excreted observed form the patient.
 Breast is engorged and
sagging.
 Discoloration is absent.
Palpation:
 no lumps noted
 Tenderness was not noted.

Inspection: Impaired skin integrity on the

ABDOMEN  Impaired skin integrity located hypogastric region due to
on hypogastric region lower segment transverse
cesarean section. cesarean section.
 Silver white striae or stretch
marks.
Palpation:
 No tenderness
 Relaxed abdomen with
smooth and consistent
tension.
 Pain indicated when palpated
near the surgical operation of
the hypogastric region.
Auscultation:
 Audible bowel sounds.
 Borborygmus noted.
Inspection:
UPPER  Crooked and long nails.
EXTREMITIES  Color of the skin is same as
the face and neck.
 Absence of bone prominence.
Palpation:
 No tenderness when
palpated.
 Not edematous.
Inspection: Edematous extremities is an
LOWER  Edematous feet noted. observable swelling from
EXTREMITIES  Crooked and long nails. fluid accumulation in
Palpation: body tissues. Swelling of
 No tenderness when the extremities is another
 palpated. sign of heart problem
 Not edematous. such as high blood
pressure

Inspection:
GENITALS  No lesions observed.
 Dark brown in color.
 Shaved mon pubis
Palpations:
 No lumps.
 Tenderness not noted.

V. LABORATORY/ DIAGNOSTIC RESULTS (Next page)

VI. SUMMARY OF MEDICATIONS/IV , BLOOD TRANSFUSIONS, TREATMENTS

MEDICATION IDEAL ACTUAL

Tramadol Dosage: 400 mg Medication was not
Freq.: once a day administered due to lack of
Route: P.O.
Supplied: tablet
supply.

Ketorolac Dosage: 30mg (3 doses) Medication was given by the

Route: IVTT nurse on duty.
Frequency: every 5 hours
Supplied: tablet

Cefuroxime 500 mg; one (1) Tablet BID
Route: Oral
Magnesium Sulfate 2.5 g through IV 5g through IM
at each buttocks q6
SUPPLIED:
 intravenous (IV) or
intramuscular (IM) routes
Medication was given to the
patient by the nurse on duty
orally.
Medication was given to the
patient Intravenously.
 Hydralazine Administer 0.5 – 1 mg Medication was given to the
intramuscular within 1 hour of patient intramuscularly.
birth.
Route:
Intramuscular;
Anterolateral right thigh
Supplied:
Tablet or injection emulsion

Amlodipine Usual Adult Dose for Patient received medication

Hypertension from the student nurse.
Initial dose: 5 mg orally once a
day
Maintenance dose: 5 to 10 mg
orally once a day
Maximum dose: 10 mg/day
Usual Adult Dose for Angina
Pectoris -
Maintenance dose: 5 to 10 mg
orally once a day
Maximum dose: 10 mg/day
Oral tablet
Dexamethasome 1.8mg IV q6 Patient received medication
Route: intravenously.
Intramuscular and intravenous
Supplied:
IVTT

Paracetamol 500 mg 1 tab Patient received medication

Route: oral from the student nurse orally.
Frequency q 4”

VII. ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM
Anatomy of the uterus
Uterus may be of several anatomical types. For example, some mammals like deer,
moose, cats etc. have bipartite uterus, pigs and dogs have bicornuate uteri, and single
uterus with a single cavity is found in humans, horses and apes.

The uterus lies in the pelvis behind the urinary bladder and in front of the rectum. The
uterus is a pear shaped muscular organ. It has four segments – the fundus (top of the
uterus), corpus (body), cervix (mouth) and the internal os (opening).

The uterus has numerous nerves, and networks of arteries and veins as well as ligaments
such as the round ligaments, cardinal ligaments, broad ligaments, and uterosacral
ligaments of uterus.

The Layers of the Uterus

The uterus is a hollow organ made up of three layers of tissue:
The Perimetrium: This is the outside layer of tissue that lines the outside of the uterus. 
The Myometrium: The middle layer of the uterus is primarily made up of smooth muscle. 
The Endometrium: The inside layer of the uterus that is the layer that builds up over the
course of a month and is shed each month if no pregnancy occurs. This shedding of the
lining of the uterus is the menstrual period.

Functions of the uterus

Functions of the uterus include nurturing the fertilized ovum that develops into the
fetus and holding it till the baby is mature enough for birth. The fertilized ovum gets
implanted into the endometrium and derives nourishment from blood vessels
which develop exclusively for this purpose. The fertilized ovum becomes an
embryo, develops into a fetus and develops until childbirth.

The uterus provides structural integrity and support to the bladder, bowel, pelvic
bones and organs as well. It separates the bladder and the bowels.

The networks of blood vessels and nerves of the uterus direct the blood flow to the
pelvis and to the external genitalia, including the ovaries, vagina, labia, and clitoris
for sexual response. The uterus is needed for uterine orgasm to occ
 CESAREAN SECTION

Cesarean Section or C-section

a surgical operation for delivering a child by cutting through the wall of the mother's
abdomen. C-section or Cesarean Delivery, is the use of surgery to deliver babies. A
caesarean section is often necessary when a vaginal delivery would put the baby or
mother at risk.
Function of the Heart

The heart circulates blood through two pathways: the pulmonary circuit and the
systemic circuit.

In the pulmonary circuit, deoxygenated blood leaves the right ventricle of the heart via
the pulmonary artery and travels to the lungs, then returns as oxygenated blood to the
left atrium of the heart via the pulmonary vein

In the systemic circuit, oxygenated blood leaves the body via the left ventricle to the
aorta, and from there enters the arteries and capillaries where it supplies the body's
tissues with oxygen. Deoxygenated blood returns via veins to the venae cavae, re-
entering the heart's right atrium.
 Hypertension
(HTN or HT) also known as high blood pressure (HBP), is a long-term medical
condition in which the blood pressure in the arteries is persistently elevated. High
blood pressure typically does not cause symptoms

VIII. MEDICAL MANAGEMENT

Ideal
Metoprolol=it is a  used to treat high blood pressure, chest pain due to poor blood flow to the heart,
and a number of conditions involving an abnormally fast heart rate.
Amlodipine=used to treat high blood pressure and coronary artery disease.
Losartan=it is used to treat high blood pressure (hypertension) and to help protect the kidneys from
damage due to diabetes.
Hydralazine=is a medication used to treat highly blood pressure and heart failure 
Lisinopril=used to treat high blood pressure, heart failure and after heart attacks.
Hydrochlorothiazide=use to treat high blood pressure and swelling due to fluid build-up
Benicar=use to treat high blood pressure, heart failure and diabetic kidney disease.

Laboratory.             
Urinalysis= a test of the urine used to detect and manage a wide range of disorders, such as
urinary tract infections, kidney disease and diabetes.
Blood type=it is a classification of blood, based on the presence and absence of antibodies and
inherited antigenic substances on the surface of red blood cells.
Partial Thromboplastin Time=is a screening test used to help evaluate a person’s ability to
appropriately form blood clots.
Prothrombin Time=a blood clot to stop bleeding, which measures how quick the blood clots.

Diagnostic.      
X-Ray=it is an imaging creates pictures of the inside of the body.
Ultrasound=imaging uses sound moves to produce pictures of the inside of the body.
Hematology Section=performs test that are important in diagnosing many disorders such as
anemia and leukemia.

Diet
Liquid diet=is a diet that mostly consist of liquids, or soft foods that melt at room temperature.
Soft diet=is made up of foods that are soft and easy to chew and swallow.
General diet=is a healthy meal plan that includes a variety of healthy foods from all foods groups.
Mechanical diet=all foods are allowed that can be made easier to chew and swallow by using
machines.

Treatment
IV fluids=regulation is the control of the amount of fluids of the patient receive in a vein through IV.
Environment=circumstances, objects or conditions by which one is surrounded. The complex of
physical, chemical and factors.
Adequate sleep=the important of indicator of health and well-being.
Proper nutrition=is by eating or consuming the majority of daily calories (fresh fruits, fresh
 vegetables, whole grains, legumes, nuts, lean proteins) the proper nutrition from the diet.
IX. SURGICAL MANAGEMENT
Surgical (Invasive or Non-Invasive)

Lower Segment Transverse Cesarean Section

 Ideal
Cesarean Section=a surgical operation for delivering a child by cutting through the wall of the
mothers abdomen.

Reason why CS=because the mother is antepartum eclampsia.

X. OUTLINE OF NURSING MANAGEMENT

GOAL Focus Nursing Interventions

Health Promotion 1. Blood Pressure  Monitor and record BP every
Monitoring hour. Measure in both arms
and thighs three times, 3–5
2. Healthy Lifestyle min apart while patient is at
rest, then sitting, then
standing for initial evaluation.
Use correct cuff size and
accurate technique.

Rationale: Comparison of
pressures provides a more
complete picture of vascular
involvement or scope of
problem. Severe
hypertension is classified in
the adult as a diastolic
pressure elevation to 110
mmHg; progressive diastolic
readings above 120 mmHg
are considered first
accelerated, then malignant
(very severe). Systolic
hypertension also is an
established risk factor for
cerebrovascular disease and
ischemic heart disease, when
diastolic pressure is elevated.

 Check laboratory data

(cardiac markers, complete
blood cell count, electrolytes,
ABGs, blood urea nitrogen
and creatinine, cardiac
enzymes, and cultures, such
as blood, wound or
secretions).
 Rationale: To identify
contributing factors

 Instructing the patient to

avoid drinking alcohol,
smoking and intake of too
much salt.

Intake of too much salt and

unhealthy lifestyle could pose
a person more at risk to
hypertension.

Disease 1. Regular Exercise  Educate patient about

Prevention disease process, treatment
2. Diet regimen, dietary changes
(Diet – DASH; Low Sodium;
3. Physical
Assessment/Regula No processed/canned foods;
r Check-up Limit caffeine/alcohol)

Rationale: Education is key

because you cannot feel
HTN. Patients must
understand how important
compliance is to prevent
major events in the future.

 Note presence, quality of

central and peripheral pulses.

Rationale: Bounding carotid,

jugular, radial, and femoral
pulses may be observed and
palpated. Pulses in the legs
and feet may be diminished,
reflecting effects of
vasoconstriction (increased
systemic vascular resistance
[SVR]) and venous
congestion.

 Auscultate heart tones and

breath sounds.

Rationale: S4 heart sound is

common in severely
hypertensive patients
 because of the presence of
atrial hypertrophy (increased
atrial volume and pressure).
Development of S3 indicates
ventricular hypertrophy and
impaired functioning.
Presence of crackles,
wheezes may indicate
pulmonary congestion
secondary to developing or
chronic heart failure.

 Observe skin color, moisture,

temperature, and capillary
refill time.

Rationale: Presence of pallor;

cool, moist skin; and delayed
capillary refill time may be
due to peripheral
vasoconstriction or reflect
cardiac decompensation and
decreased output.

 Note dependent and general

edema.

Rationale: May indicate heart

failure, renal or vascular
impairment.

Curative 1. Proper Compliance  Administer BP lowering

to the prescribed agents at appropriate time.
Medications and May need to adjust timing to
Treatments avoid larger drops in BP.

Rationale: BP meds may

need to be spaced out so
they all don’t peak at the
same time and cause a drop
in blood pressure. It’s better
to have consistent control
throughout the day and night.

 Administer Calcium channel

antagonists as prescribed by
the physician

Rationale: May be necessary

to treat severe hypertension
 when a combination of a
diuretic and a sympathetic
inhibitor does not sufficiently
control BP. Vasodilation of
healthy cardiac vasculature
and increased coronary blood
flow are secondary benefits
of vasodilator therapy.

 Assess and control pain

Rationale: Pain will increase

blood pressure. Control as
much as possible and time
appropriately with activity.
Patient may also experience
angina - be sure to do a full
pain assessment and
intervene as appropriate.
Rehabilitation 1. Providing  Evaluate client reports or
environment evidence of extreme fatigue,
conducive for care intolerance for activity,
sudden or progressive weight
gain, swelling of extremities,
and progressive shortness of
breath.

Rationale: To assess for

signs of poor ventricular
function or impending cardiac
failure.

 Provide calm, restful

surroundings, minimize
environmental activity and
noise. Limit the number of
visitors and length of stay.

Rationale: Helps lessen

sympathetic stimulation;
promotes relaxation.

 Maintain activity restrictions

(bedrest or chair rest);
schedule periods of
uninterrupted rest; assist
patient with self-care
activities as needed.

Rationale: Lessens physical

 stress and tension that affect
blood pressure and the
course of hypertension.

 Provide comfort measures

(back and neck massage,
elevation of head).

Rationale: Decreases
discomfort and may reduce
sympathetic stimulation.

 Instruct in relaxation
techniques, guided imagery,
distractions.

Rationale: Can reduce

stressful stimuli, produce
calming effect, thereby
reducing BP.